John C Hagan III, MD, FACS, FAAO
John C Hagan III, MD, FACS, FAAO
Male
Kansas City, MO
Specialties: Ophthalmology
Interests: Eye-Medical Blog
Male
Kansas City, MO
Specialties: Ophthalmology
Interests: Eye-Medical Blog
Discover Vision Centers of Kansas City
Missouri Medicine medical journal Editor
(816) 478-1230 Kansas City, MO
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Jul 14, 2011 - 18 comments
FROM: John C. Hagan III MD, FACS, FAAO This is a reprint of an editorial in the July 2011 American Journal of Ophthalmology and represents the latest information on floaters. It references a second article from the same issue which I will also post.
ARTICLE FOLLOWS:
In 1976, Dr Ernst Wynder, founding president of the American Health Foundation and founding editor of the journal Preventive Medicine, stated that “It should be the function of medicine to help people die young…as late in life as possible.”1 However, medicine in general, and ophthalmology in specific, are disease-oriented disciplines. In the former case, this is due to the fact that “Disease is a living experience for the man of flesh and bone. In contrast, health is a disembodied concept. It stimulates no emotional response because it is an inhuman, fleshless abstraction” (René Jules Dubos, The Silliman Lectures, Yale, 1965).1 As ophthalmologists, we are trained to evaluate eyes by seeking evidence of disease using biomicroscopy and ophthalmoscopy, as well as with diagnostic testing. When we rule out pathology by these modalities, we advise patients that they are free of disease. Such advice is apparently a frustrating and unfulfilling experience for patients with “floaters.” From their point of view, the consulting ophthalmologist who sought evidence of disease and found none has nonetheless failed to address their health and quality-of-life issues.
In youth, vitreous is a solid and clear gel filling the center of the eye, firmly attached to the retina. The exquisite transparency of vitreous allows unhindered transmission of light to the retina for photoreception.2 Other than “exogenous” sources, such as hemorrhage and inflammation, there are 2 main causes of the entopic phenomenon called “floaters,” which result from light scattering by structures within the vitreous body and/or at the posterior vitreous cortex. Although devoid of liquid during infancy, the vitreous body begins to liquefy in childhood due to molecular rearrangement of the constituent macromolecules hyaluronan and collagen. Part of this molecular alteration involves cross-linking and aggregation of vitreous collagen fibrils. If advanced, fibrillar aggregation can cause sufficient interference of photon transmission to induce chronic and progressive floaters. In myopia, the process of vitreous gel liquefaction and fibrillar aggregation appears to be accelerated, a manifestation of myopic vitreopathy.3
Concurrent with vitreous gel liquefaction, there is weakening of vitreoretinal adhesion. When both processes advance in tandem to a critical threshold,2, 3 there is separation of the posterior vitreous cortex from the retina, perhaps initially only in the perifoveal region.4 Displacement of liquefied vitreous into the developing cleavage plane between the posterior vitreous cortex and the internal limiting lamina of the retina collapses the posterior vitreous away from the retina, an event called posterior vitreous detachment (PVD). While it has long been taught that PVD is abnormal, it may well be that PVD is the salubrious result of evolutionary progress. This concept arises from the growing awareness that in a variety of diseases, such as diabetic retinopathy5 and age-related macular degeneration6, 7 (AMD), PVD is a far safer condition. That notwithstanding, entopic phenomena resulting from this event induce acute floaters. These arise from the posterior vitreous cortex itself as well as tissue that is sometimes adherent to the posterior vitreous cortex, typically parapapillary fibro-glial in origin. When attributable to myopic vitreopathy,3 PVD occurs 10 to 15 years earlier in life.
The subjective experience of sudden floaters is very common after PVD. While many patients complain that this is bothersome, ophthalmologists tend to pay little heed to these symptoms other than to rule out anomalous PVD3, 8 manifesting as either peripheral or posterior retinal pathology. Once the absence of disease has been assured, the typical eye care professional ceases to be concerned about the issue of floaters. While the Hippocratic principle of “primum non nocere” has guided our approach to date, it may well be time to reexamine our perception that floaters are simply an innocuous, indeed curiously desirable, manifestation of the “normal” aging process.
In this issue of the Journal, Wagle and associates9 present fascinating new information concerning the utility value of floaters, as expressed by patients. Utility values allow an objective quantification of the functional quality of life associated with a specific “disease” state. A utility value of 1.0 implies a perfect “health” state, while death has a utility value of 0.0. The findings of this study indicate that the utility values of floaters are equal to AMD and lower than diabetic retinopathy and glaucoma. According to this study, floaters have lower utility values than mild angina, mild stroke, colon cancer, and asymptomatic HIV infection. This indicates that floaters have a significant negative impact on the quality of life as compared to ocular as well as systemic diseases. It is interesting to note that there was no difference between acute (less than 1 month) and chronic (mean duration of more than 1 year) floaters. This finding throws into question our long-held belief and oft-offered counsel to patients that their symptoms will lessen in severity, either due to settling of vitreous opacities below the optical axis or because of neuro-psychological adaptation. Surprisingly, the investigators claimed that 49.3% of the study group had no PVD. This is suspect, since subjects only underwent an examination and not diagnostic testing, such as ultrasound or optical coherence tomography. Furthermore, 56% of the subjects were women and 59.7% were myopic—both known to predispose to PVD. On the other hand, the authors appropriately point out that the retinal magnification of the images associated with myopia can make floaters seem more pronounced, perhaps explaining how a large number of subjects in this study complained of floaters in the absence of a PVD.
Most remarkably, the investigators of this study found that these patients were willing to take an 11% risk of death and a 7% risk of blindness to get rid of symptoms related to floaters. As the authors state, patients with floaters are willing to trade off 1.1 years out of every 10 years of their remaining lives to get rid of the symptoms of floaters. To some extent that explains the willingness of patients to undergo unproven attempts at mitigating their symptoms, such as YAG laser vitreolysis, for which there is no evidence of efficacy. Definitive treatment is available with vitrectomy, which has been rendered faster, less invasive, and safer by the advent of 25G instrumentation. Yet, there are small risks associated with this invasive procedure and in phakic patients there are lens-related considerations. To obviate the cost and risk (albeit small) of surgery, the future will likely see the development of drug therapy for floaters, via pharmacologic vitreolysis.10 Caution must be exercised, however, for some agents may induce or aggravate floaters as opposed to dissolve them.10, 11
Future advances in our ability to promote health and not just treat disease will depend upon a paradigm shift in philosophy and the development of technologies for health evaluation. We should first accept health as its own diagnosis1 and not just the absence of disease. Improving our understanding and management of conditions such as age-related vitreous degeneration,2, 3 diabetic vitreopathy,12 and myopic vitreopathy3 will then depend upon developing new diagnostic nanotechnologies, such as dynamic light scattering (DLS). This noninvasive, laser-based nano-detector is able to quantitate particle sizes in the cornea, lens, aqueous, and vitreous13 as small as 3 nm in diameter. DLS has been used to determine an alpha-crystallin index in 380 lenses of human eyes14 as well as demonstrate the effects of diabetic vitreopathy11 and pharmacologic vitreolysis.15, 16 In the meantime, however, we need to be aware of and sensitive to the fact that there continues to be a proliferation of floater websites on the internet and the formation of international floater organizations, as expressions of patient frustration with our inability or unwillingness to help them die young, as late in life as possible.
Back to Article Outline
The author indicates no funding support. The author has been a consultant to Pfizer, Shire, Storz, Alcon, ISTA, Vitreo-Retinal Technologies, and ThromboGenics, and is a shareholder in ThromboGenics, Ltd. The author (J.S.) is solely responsible for the conceptualization of this article; collection, management, analysis, and interpretation of data; and preparation, review, and approval of the manuscript.
Back to Article Outline
References
1.Sebag J. The diagnosis of health (First Prize, National Essay Competition). Preventive Medicine. 1979;8(1):76–78
View In ArticleMEDLINECrossRef
2.Sebag J. The Vitreous—Structure, Function and Pathobiology. New York: Springer-Verlag; 1989;
View In Article
3.Sebag J, Yee KMP. Vitreous—from biochemistry to clinical relevance. In: Tasman W, Jaeger EA editor. Duane's Foundations of Clinical Ophthalmology, Vol. 1. Philadelphia: Lippincott Williams & Wilkins; 2007;p. 1–67
View In Article
4.Johnson MW. Perifoveal vitreous detachment and its macular complications [thesis]. Trans Am Ophthalmol Soc. 2005;103:537–567
View In Article
5.Akiba J, Arzabe CW, Trempe CL. Posterior vitreous detachment and neovascularization in diabetic retinopathy. Ophthalmology. 1990;97(7):889–891
View In ArticleAbstract
6.Krebs I, Brannath W, Glittenberg K, et al. Posterior vitreo-macular adhesion: a potential risk factor for exudative age-related macular degeneration. Am J Ophthalmol. 2007;144(5):741–746
View In ArticleAbstractFull TextFull-Text PDF (1237 KB) CrossRef
7.Robison C, Krebs I, Binder S, et al. Vitreo-macular adhesion in active and end-stage age-related macular degeneration. Am J Ophthalmol. 2009;148(1):79–82
View In ArticleAbstractFull TextFull-Text PDF (916 KB) CrossRef
8.Sebag J. Anomalous PVD—a unifying concept in vitreo-retinal diseases. Graefes Arch Clin Exp Ophthalmol. 2004;242(8):690–698
View In ArticleCrossRef
9.Wagle AM, Lim W-Y, Yap T-P, Neelam K, Au Eong K-G. Utility values associated with vitreous floaters. Am J Ophthalmol. 2011;152(1):60–65
View In ArticleAbstractFull TextFull-Text PDF (573 KB) CrossRef
10.Sebag J. Pharmacologic vitreolysis [guest editorial]. Retina. 1998;18(1):1–3
View In ArticleCrossRef
11.Sebag J. Pharmacologic vitreolysis—premise and promise of the first decade [guest editorial]. Retina. 2009;29(7):871–874
View In ArticleCrossRef
12.Sebag J. Diabetic vitreopathy [guest editorial]. Ophthalmology. 1996;103(2):205–206
View In Article
13.Ansari RR, Dunker S, Suh K, et al. Quantitative molecular characterization of bovine vitreous and lens with non-invasive dynamic light scattering. Exp Eye Res. 2001;73(6):859–866
View In ArticleMEDLINECrossRef
14.Datiles MB, Ansari RR, Suh KI, et al. Clinical detection of precataractous lens protein changes using dynamic light scattering. Arch Ophthalmol. 2008;126(12):1687–1693
View In ArticleCrossRef
15.Sebag J. Molecular biology of pharmacologic vitreolysis [thesis]. Trans Am Ophthalmol Soc. 2005;103:473–494
View In Article
16.Sebag J, Ansari RR, Suh KI. Pharmacologic vitreolysis with microplasmin increases vitreous diffusion coefficients. Graefes Arch Clin Exp Ophthalmol. 2007;245(4):576–580
View In ArticleCrossRef
A graduate of Columbia & Harvard, Jerry Sebag is considered a leading authority on vitreous. He is Founding Director of the VMR Institute in Huntington Beach, California (www.VMRinstitute.com), Professor of Clinical Ophthalmology at the Doheny Eye Institute of USC, Fellow of the American College of Surgeons, and Fellow of the Royal College of Ophthalmologists (United Kingdom). In 2005, Dr. Sebag was inducted into the American Ophthalmological Society, and in 2010 he was designated a Fellow of ARVO.
ARTICLE FOLLOWS:
In 1976, Dr Ernst Wynder, founding president of the American Health Foundation and founding editor of the journal Preventive Medicine, stated that “It should be the function of medicine to help people die young…as late in life as possible.”1 However, medicine in general, and ophthalmology in specific, are disease-oriented disciplines. In the former case, this is due to the fact that “Disease is a living experience for the man of flesh and bone. In contrast, health is a disembodied concept. It stimulates no emotional response because it is an inhuman, fleshless abstraction” (René Jules Dubos, The Silliman Lectures, Yale, 1965).1 As ophthalmologists, we are trained to evaluate eyes by seeking evidence of disease using biomicroscopy and ophthalmoscopy, as well as with diagnostic testing. When we rule out pathology by these modalities, we advise patients that they are free of disease. Such advice is apparently a frustrating and unfulfilling experience for patients with “floaters.” From their point of view, the consulting ophthalmologist who sought evidence of disease and found none has nonetheless failed to address their health and quality-of-life issues.
In youth, vitreous is a solid and clear gel filling the center of the eye, firmly attached to the retina. The exquisite transparency of vitreous allows unhindered transmission of light to the retina for photoreception.2 Other than “exogenous” sources, such as hemorrhage and inflammation, there are 2 main causes of the entopic phenomenon called “floaters,” which result from light scattering by structures within the vitreous body and/or at the posterior vitreous cortex. Although devoid of liquid during infancy, the vitreous body begins to liquefy in childhood due to molecular rearrangement of the constituent macromolecules hyaluronan and collagen. Part of this molecular alteration involves cross-linking and aggregation of vitreous collagen fibrils. If advanced, fibrillar aggregation can cause sufficient interference of photon transmission to induce chronic and progressive floaters. In myopia, the process of vitreous gel liquefaction and fibrillar aggregation appears to be accelerated, a manifestation of myopic vitreopathy.3
Concurrent with vitreous gel liquefaction, there is weakening of vitreoretinal adhesion. When both processes advance in tandem to a critical threshold,2, 3 there is separation of the posterior vitreous cortex from the retina, perhaps initially only in the perifoveal region.4 Displacement of liquefied vitreous into the developing cleavage plane between the posterior vitreous cortex and the internal limiting lamina of the retina collapses the posterior vitreous away from the retina, an event called posterior vitreous detachment (PVD). While it has long been taught that PVD is abnormal, it may well be that PVD is the salubrious result of evolutionary progress. This concept arises from the growing awareness that in a variety of diseases, such as diabetic retinopathy5 and age-related macular degeneration6, 7 (AMD), PVD is a far safer condition. That notwithstanding, entopic phenomena resulting from this event induce acute floaters. These arise from the posterior vitreous cortex itself as well as tissue that is sometimes adherent to the posterior vitreous cortex, typically parapapillary fibro-glial in origin. When attributable to myopic vitreopathy,3 PVD occurs 10 to 15 years earlier in life.
The subjective experience of sudden floaters is very common after PVD. While many patients complain that this is bothersome, ophthalmologists tend to pay little heed to these symptoms other than to rule out anomalous PVD3, 8 manifesting as either peripheral or posterior retinal pathology. Once the absence of disease has been assured, the typical eye care professional ceases to be concerned about the issue of floaters. While the Hippocratic principle of “primum non nocere” has guided our approach to date, it may well be time to reexamine our perception that floaters are simply an innocuous, indeed curiously desirable, manifestation of the “normal” aging process.
In this issue of the Journal, Wagle and associates9 present fascinating new information concerning the utility value of floaters, as expressed by patients. Utility values allow an objective quantification of the functional quality of life associated with a specific “disease” state. A utility value of 1.0 implies a perfect “health” state, while death has a utility value of 0.0. The findings of this study indicate that the utility values of floaters are equal to AMD and lower than diabetic retinopathy and glaucoma. According to this study, floaters have lower utility values than mild angina, mild stroke, colon cancer, and asymptomatic HIV infection. This indicates that floaters have a significant negative impact on the quality of life as compared to ocular as well as systemic diseases. It is interesting to note that there was no difference between acute (less than 1 month) and chronic (mean duration of more than 1 year) floaters. This finding throws into question our long-held belief and oft-offered counsel to patients that their symptoms will lessen in severity, either due to settling of vitreous opacities below the optical axis or because of neuro-psychological adaptation. Surprisingly, the investigators claimed that 49.3% of the study group had no PVD. This is suspect, since subjects only underwent an examination and not diagnostic testing, such as ultrasound or optical coherence tomography. Furthermore, 56% of the subjects were women and 59.7% were myopic—both known to predispose to PVD. On the other hand, the authors appropriately point out that the retinal magnification of the images associated with myopia can make floaters seem more pronounced, perhaps explaining how a large number of subjects in this study complained of floaters in the absence of a PVD.
Most remarkably, the investigators of this study found that these patients were willing to take an 11% risk of death and a 7% risk of blindness to get rid of symptoms related to floaters. As the authors state, patients with floaters are willing to trade off 1.1 years out of every 10 years of their remaining lives to get rid of the symptoms of floaters. To some extent that explains the willingness of patients to undergo unproven attempts at mitigating their symptoms, such as YAG laser vitreolysis, for which there is no evidence of efficacy. Definitive treatment is available with vitrectomy, which has been rendered faster, less invasive, and safer by the advent of 25G instrumentation. Yet, there are small risks associated with this invasive procedure and in phakic patients there are lens-related considerations. To obviate the cost and risk (albeit small) of surgery, the future will likely see the development of drug therapy for floaters, via pharmacologic vitreolysis.10 Caution must be exercised, however, for some agents may induce or aggravate floaters as opposed to dissolve them.10, 11
Future advances in our ability to promote health and not just treat disease will depend upon a paradigm shift in philosophy and the development of technologies for health evaluation. We should first accept health as its own diagnosis1 and not just the absence of disease. Improving our understanding and management of conditions such as age-related vitreous degeneration,2, 3 diabetic vitreopathy,12 and myopic vitreopathy3 will then depend upon developing new diagnostic nanotechnologies, such as dynamic light scattering (DLS). This noninvasive, laser-based nano-detector is able to quantitate particle sizes in the cornea, lens, aqueous, and vitreous13 as small as 3 nm in diameter. DLS has been used to determine an alpha-crystallin index in 380 lenses of human eyes14 as well as demonstrate the effects of diabetic vitreopathy11 and pharmacologic vitreolysis.15, 16 In the meantime, however, we need to be aware of and sensitive to the fact that there continues to be a proliferation of floater websites on the internet and the formation of international floater organizations, as expressions of patient frustration with our inability or unwillingness to help them die young, as late in life as possible.
Back to Article Outline
The author indicates no funding support. The author has been a consultant to Pfizer, Shire, Storz, Alcon, ISTA, Vitreo-Retinal Technologies, and ThromboGenics, and is a shareholder in ThromboGenics, Ltd. The author (J.S.) is solely responsible for the conceptualization of this article; collection, management, analysis, and interpretation of data; and preparation, review, and approval of the manuscript.
Back to Article Outline
References
1.Sebag J. The diagnosis of health (First Prize, National Essay Competition). Preventive Medicine. 1979;8(1):76–78
View In ArticleMEDLINECrossRef
2.Sebag J. The Vitreous—Structure, Function and Pathobiology. New York: Springer-Verlag; 1989;
View In Article
3.Sebag J, Yee KMP. Vitreous—from biochemistry to clinical relevance. In: Tasman W, Jaeger EA editor. Duane's Foundations of Clinical Ophthalmology, Vol. 1. Philadelphia: Lippincott Williams & Wilkins; 2007;p. 1–67
View In Article
4.Johnson MW. Perifoveal vitreous detachment and its macular complications [thesis]. Trans Am Ophthalmol Soc. 2005;103:537–567
View In Article
5.Akiba J, Arzabe CW, Trempe CL. Posterior vitreous detachment and neovascularization in diabetic retinopathy. Ophthalmology. 1990;97(7):889–891
View In ArticleAbstract
6.Krebs I, Brannath W, Glittenberg K, et al. Posterior vitreo-macular adhesion: a potential risk factor for exudative age-related macular degeneration. Am J Ophthalmol. 2007;144(5):741–746
View In ArticleAbstractFull TextFull-Text PDF (1237 KB) CrossRef
7.Robison C, Krebs I, Binder S, et al. Vitreo-macular adhesion in active and end-stage age-related macular degeneration. Am J Ophthalmol. 2009;148(1):79–82
View In ArticleAbstractFull TextFull-Text PDF (916 KB) CrossRef
8.Sebag J. Anomalous PVD—a unifying concept in vitreo-retinal diseases. Graefes Arch Clin Exp Ophthalmol. 2004;242(8):690–698
View In ArticleCrossRef
9.Wagle AM, Lim W-Y, Yap T-P, Neelam K, Au Eong K-G. Utility values associated with vitreous floaters. Am J Ophthalmol. 2011;152(1):60–65
View In ArticleAbstractFull TextFull-Text PDF (573 KB) CrossRef
10.Sebag J. Pharmacologic vitreolysis [guest editorial]. Retina. 1998;18(1):1–3
View In ArticleCrossRef
11.Sebag J. Pharmacologic vitreolysis—premise and promise of the first decade [guest editorial]. Retina. 2009;29(7):871–874
View In ArticleCrossRef
12.Sebag J. Diabetic vitreopathy [guest editorial]. Ophthalmology. 1996;103(2):205–206
View In Article
13.Ansari RR, Dunker S, Suh K, et al. Quantitative molecular characterization of bovine vitreous and lens with non-invasive dynamic light scattering. Exp Eye Res. 2001;73(6):859–866
View In ArticleMEDLINECrossRef
14.Datiles MB, Ansari RR, Suh KI, et al. Clinical detection of precataractous lens protein changes using dynamic light scattering. Arch Ophthalmol. 2008;126(12):1687–1693
View In ArticleCrossRef
15.Sebag J. Molecular biology of pharmacologic vitreolysis [thesis]. Trans Am Ophthalmol Soc. 2005;103:473–494
View In Article
16.Sebag J, Ansari RR, Suh KI. Pharmacologic vitreolysis with microplasmin increases vitreous diffusion coefficients. Graefes Arch Clin Exp Ophthalmol. 2007;245(4):576–580
View In ArticleCrossRef
A graduate of Columbia & Harvard, Jerry Sebag is considered a leading authority on vitreous. He is Founding Director of the VMR Institute in Huntington Beach, California (www.VMRinstitute.com), Professor of Clinical Ophthalmology at the Doheny Eye Institute of USC, Fellow of the American College of Surgeons, and Fellow of the Royal College of Ophthalmologists (United Kingdom). In 2005, Dr. Sebag was inducted into the American Ophthalmological Society, and in 2010 he was designated a Fellow of ARVO.
I am glad you posted this. For 17 years ( begining in 1980 ) I struggled with the symptoms of vitreous traction and floaters. If I looked at the face of a person, it seemed as if one eye was missing. After the PVD ( without a tear ) 14 years ago this symptom slowly went away. This is a total of 31 years with floaters. I am -7 myopic with a very liquid vitreous. I had a weiss ring as well as numerous small and very mobile floaters, including a string that would settle into the center of my vison and stay there for hours.
I finally made a decision to pursue treatment and traveled to Memphis 2 years ago and have an excellent outcome. I was told that I had a definite PVD which helped with a successful result. I may consider the other eye as well but this is currently a condition which requires the patient to just do what they feel must be done and hope for the best with almost no support from anyone.
I finally made a decision to pursue treatment and traveled to Memphis 2 years ago and have an excellent outcome. I was told that I had a definite PVD which helped with a successful result. I may consider the other eye as well but this is currently a condition which requires the patient to just do what they feel must be done and hope for the best with almost no support from anyone.
Glad things worked out well for you. It is very difficult to recommend vitrectomies for floaters that merely annoy people because of the truly enormous expense of previous health care dollars and the amount of time this would take from precious resources (retina surgeons, retina equipped operating rooms and staffs) plus the inevitable eyes that have infections, develop cataracts, have retinal detachments, are still bothered by floaters, have macular swelling (edema).
Glad it went well in your case.
JCH MD
Glad it went well in your case.
JCH MD
Dr. John C Hagan III,
Your concerns regarding complications are valid, however, it does not mean that just because there are risks associated with vitrectomy, no advancements should be made to develop a safer technique for patients suffering with floaters. Yes vitrectomy for floaters will take away precious resources from "retina surgeons and retina equipped operation rooms and staffs" but those resources have the reason to exist, in the first place, to help patients, no? As a scientific study backed with shattering evidence published in this 2011 issue show that floaters can be a debilitating condition for many people, and hence they are patients. Such resources should help patients following the principle of "doing no harm," which includes psychological harm that comes to patients who suffer with floaters.
Regards
Your concerns regarding complications are valid, however, it does not mean that just because there are risks associated with vitrectomy, no advancements should be made to develop a safer technique for patients suffering with floaters. Yes vitrectomy for floaters will take away precious resources from "retina surgeons and retina equipped operation rooms and staffs" but those resources have the reason to exist, in the first place, to help patients, no? As a scientific study backed with shattering evidence published in this 2011 issue show that floaters can be a debilitating condition for many people, and hence they are patients. Such resources should help patients following the principle of "doing no harm," which includes psychological harm that comes to patients who suffer with floaters.
Regards
And I am a medical student, only I know how much I am suffering day in and out with those floaters as well as lattice degeneration while I try to balance my work and study responsibilities with my personal life. I have not gotten vitrectomy yet, but I am hoping that soon there will be safer techniques to help me, God willing.
I can't understand why the medical community doesn't really care about floaters when it is well known how many people around the world are suffering because of them.
The "ignore" solution doesn't work for me and for many others too. Floaters can ruin your life, when you can't ignore them, and especially can lead you to suicide when you see that what you're trying to do and achieve, can't be done, because there are some black dots flying around in your eyes, and not letting you concentrate
I don't get it, floaters ARE a huge problem, they maybe are not risky for your life or vision, but they LOWER your quality of life, this is the same as having a flu or a headache that won't go away. It's the same thing.
And for me, I would prefer to have a fatal disease that has actually a cure, than these little monsters in my eyes until I die.
I CAN'T ignore them I want them to LEAVE ME ALONE.
WHY don't you doctors care? why? can you tell me?
The "ignore" solution doesn't work for me and for many others too. Floaters can ruin your life, when you can't ignore them, and especially can lead you to suicide when you see that what you're trying to do and achieve, can't be done, because there are some black dots flying around in your eyes, and not letting you concentrate
I don't get it, floaters ARE a huge problem, they maybe are not risky for your life or vision, but they LOWER your quality of life, this is the same as having a flu or a headache that won't go away. It's the same thing.
And for me, I would prefer to have a fatal disease that has actually a cure, than these little monsters in my eyes until I die.
I CAN'T ignore them I want them to LEAVE ME ALONE.
WHY don't you doctors care? why? can you tell me?
Km12321: Dense opacities in vitreous (severe floaters) that appear to us patients as dark dots, webs and strings distort light when they come into central vision axis, because of the changes in refractive index. Hence, such floaters are WORSE than having a chronic flu. Why? All my life, most of which is spent in wards looking at patients and doing physicals on them, involves the dire need for me to use my vision. I do not use my nose or throat to do a physical exam on patients. I use my eyes to look at their organs in question, to perform physical tests on them.
Of course chronic flu would decrease quality of life for me as well but at flying black dots, black cobwebs and black tube worms, which actually DISTORT light and colors, decrease my quality of life to such an extent that many a times Ive contemplated gorging my eye balls out for good.
Of course chronic flu would decrease quality of life for me as well but at flying black dots, black cobwebs and black tube worms, which actually DISTORT light and colors, decrease my quality of life to such an extent that many a times Ive contemplated gorging my eye balls out for good.
I understand how you feel as I'm actually feeling the same, I'm a computer science student and I'm actually working all day long on my computer and these black things make it more difficult for me to work, I'm trying to just "live with them" but it's not possible..
as you say, I would also prefer to have anything else than these things....... I'm really mad at the doctors who don't care about the sufferers of floaters...
We have such a great technology..... since there are no medicine for these things, why don't they create some kind of "robots" that would remove all the floaters in the eyes? for example, a simple mechanism that could be put in the eye, can just scan it by moving around and removing anything that "seems" like a floater, it's not a medicine, but at least it can be done without a surgery but with a simple injection that would put this mechanism in the eye, and then after the procedure is finished, the mechanism would wither destroy itself, or it would find a way out through our inner system... there MUST be a way out, once you're in the eye.. maybe the floaters can't find this way, but maybe something made by us, would be able to find it...
well these are just assumptions.. I don't even know if this is even possible, but with the technology as it is today, EVERYTHING is possible..
I won't try FOV or laser, because both are not quite acceptable by everyone, there are always risks, and I don't feel like ruining my eye by removing the gel using fov, because I'm just 20 and maybe in 10 years I will get some more serious eye problem... about the laser, I don't feel like it is effective, since after researching for a while I've read that 50% of patients are pleased with the results, other 50% say they are not pleased etc..
i don't know what to say...... maybe a real sufferer like us one day will just open a book and start a solid research in order to find something that would cure these little monsters... but until then, we can only hope and wait...
as you say, I would also prefer to have anything else than these things....... I'm really mad at the doctors who don't care about the sufferers of floaters...
We have such a great technology..... since there are no medicine for these things, why don't they create some kind of "robots" that would remove all the floaters in the eyes? for example, a simple mechanism that could be put in the eye, can just scan it by moving around and removing anything that "seems" like a floater, it's not a medicine, but at least it can be done without a surgery but with a simple injection that would put this mechanism in the eye, and then after the procedure is finished, the mechanism would wither destroy itself, or it would find a way out through our inner system... there MUST be a way out, once you're in the eye.. maybe the floaters can't find this way, but maybe something made by us, would be able to find it...
well these are just assumptions.. I don't even know if this is even possible, but with the technology as it is today, EVERYTHING is possible..
I won't try FOV or laser, because both are not quite acceptable by everyone, there are always risks, and I don't feel like ruining my eye by removing the gel using fov, because I'm just 20 and maybe in 10 years I will get some more serious eye problem... about the laser, I don't feel like it is effective, since after researching for a while I've read that 50% of patients are pleased with the results, other 50% say they are not pleased etc..
i don't know what to say...... maybe a real sufferer like us one day will just open a book and start a solid research in order to find something that would cure these little monsters... but until then, we can only hope and wait...
The best solution is try to learn to live with it.I had floaters for one years.Now i get adjusted to floaters.Does floaters have any relation with strength training(heavy weight training).I read somewhere that weighttraing increases IOP pressure.So i stopped my weight training .Nice post doctor
From Dr. Hagan: If it's any consilation to readers, I have floaters in both eyes. Have had since childhood. In the last two years I've had a huge Weiss ring floater in my right eye. Anytime I talk to a patient about them or type a message on the Eye Forum I become aware of them. Nevertheless I would never consider a vitrectomy because of the risks and that usually that procedure causes cataracts to develop or progress.
Any postings about the ophthalmology profession not caring about floaters indicates the poster has either not read the two articles I posted on this blog or fails to comprehend what is saying. One article documents the deep concern some people have about their floaters, other articles outline the research being done for them: surgical I(vitrectomy) and disolving (vitreolysis); lasers have been tried but were not successful.
John Hagan MD
Any postings about the ophthalmology profession not caring about floaters indicates the poster has either not read the two articles I posted on this blog or fails to comprehend what is saying. One article documents the deep concern some people have about their floaters, other articles outline the research being done for them: surgical I(vitrectomy) and disolving (vitreolysis); lasers have been tried but were not successful.
John Hagan MD
@ John C Hagan,
"Nevertheless I would never consider a vitrectomy because of the risks and that usually that procedure causes cataracts to develop or progress. "
This shows that you only have mild floater symptoms as anyone with serious floaters would trade their floaters with cataract any day.
"Nevertheless I would never consider a vitrectomy because of the risks and that usually that procedure causes cataracts to develop or progress. "
This shows that you only have mild floater symptoms as anyone with serious floaters would trade their floaters with cataract any day.
Its good to see that the medical profession is taking this condition more seriously. Hopefully there will be more research done and a safer less invasive solution will be found. There is no doubt that with a growing population (and an aging population) that there will be increasing numbers of people who suffer. I am learning to live with mine but one cannot help but think that I will never completely get used to them. It has negatively affected my productivity at work and my enjoyment of life. A pharmaceutical solution would be a money spinner for sure.
I cope with persistant floaters everyday and have for years. I know many people that have had them for decades and are still bothered by them. On tv, and in the news, I see new treatments developed for more benign conditions. I am told my floaters are not serious enough to justify vitrectomy. You imply your profession cares about this problem. Can you post any current research or development into better treatments for floaters? Surely for something that affects millions in the U. S alone it would deserve funding, but I don't know of any active studies into better treatment options, prevention or etiology.
With all the medical technology today I am surprised that no one has come up with a (non invasive) solution you can inject into the eye that could dissolve the "gel" floaters. Flosters are just gel.....why is this so difficult?
I've lived with floaters for the past 10 years and now I have one floater that stays in my central vision and is driving me crazy. I am very nearsighted (-10 and -14) so I would never have them removed, the risk is just too great.
I've lived with floaters for the past 10 years and now I have one floater that stays in my central vision and is driving me crazy. I am very nearsighted (-10 and -14) so I would never have them removed, the risk is just too great.
I had ONE black dot in one eye after using an inversion machine. It went away. Then I had a mass of floaters flood in that eye, and found I had a tear in my retina. The tear was lasered.
A few doctor appts later, the doc decided I needed MORE laser. I thought I had another tear. I didn't. My employee benefit statement said "Preventative laser surgery."
4 months later, I was told my retina was detached, although I had no symptoms. I underwent surgery for RD, after surgery I had a huge pool of blood under my eye. I later found in my records that a hyphema was created. ( I was never told the word hyphema, so I looked it up. It is when blood fills up the FRONT of the eye, due to blunt force trauma. (blunt force trauma?-when, during surgery?) My hyphema was clotted. It was written, but I was never told.
After THAT surgery, I had and have floaters in my other eye, and the operated eye sees to the left and down and is very distorted, and looks to the right and up. It is disgusting looking. My pupil is irregular and so is my whole eye. My iris is cut. The other eye is still 20/20.
My doctors did not tell me anything. And I did not know much about the eye, PVDs, floaters, etc. But I sure do now!
I found out later, after researching for MYSELF what had happened. I had an acute PVD that caused a tear. (with flashes and floaters) The eye needed laser because fluid got under the tear. The second time my eye was lasered, I thought there was another tear.
Lasers do not always fix or prevent. Sometimes too much laser CAUSES a bigger problem.
And our doctors need to tell us EXACTLY what they are doing and why, not write everything in our records with a note that says they discussed this with the patient, and the patient agrees, when they surely did NOT.
Just my thought for the day.
A few doctor appts later, the doc decided I needed MORE laser. I thought I had another tear. I didn't. My employee benefit statement said "Preventative laser surgery."
4 months later, I was told my retina was detached, although I had no symptoms. I underwent surgery for RD, after surgery I had a huge pool of blood under my eye. I later found in my records that a hyphema was created. ( I was never told the word hyphema, so I looked it up. It is when blood fills up the FRONT of the eye, due to blunt force trauma. (blunt force trauma?-when, during surgery?) My hyphema was clotted. It was written, but I was never told.
After THAT surgery, I had and have floaters in my other eye, and the operated eye sees to the left and down and is very distorted, and looks to the right and up. It is disgusting looking. My pupil is irregular and so is my whole eye. My iris is cut. The other eye is still 20/20.
My doctors did not tell me anything. And I did not know much about the eye, PVDs, floaters, etc. But I sure do now!
I found out later, after researching for MYSELF what had happened. I had an acute PVD that caused a tear. (with flashes and floaters) The eye needed laser because fluid got under the tear. The second time my eye was lasered, I thought there was another tear.
Lasers do not always fix or prevent. Sometimes too much laser CAUSES a bigger problem.
And our doctors need to tell us EXACTLY what they are doing and why, not write everything in our records with a note that says they discussed this with the patient, and the patient agrees, when they surely did NOT.
Just my thought for the day.
Kathrin,
Loved ur post. My son 23, has been severly near sighted and boom with no warning he had detachment. Why did no Dr. ever warn us this could happen? I ask this because he was out of state on an oil rig in the middle of nowhere and had no idea what was happening. Hence, to late. He finaly 2 days went in for emergency appt. was then put on a plane home and 2 more days before surgery. He must have dep preception ect. to continue on his career path and somw vision. We now do not know if he will ever see again. If he or I had known anything about this we would have taken care and had the freeze done the same way we had his other eye done so this will hopeful never happen to it. Any answers or help would b much appreciated. For at 45 i can or could function but at 23 it is so much different.
Loved ur post. My son 23, has been severly near sighted and boom with no warning he had detachment. Why did no Dr. ever warn us this could happen? I ask this because he was out of state on an oil rig in the middle of nowhere and had no idea what was happening. Hence, to late. He finaly 2 days went in for emergency appt. was then put on a plane home and 2 more days before surgery. He must have dep preception ect. to continue on his career path and somw vision. We now do not know if he will ever see again. If he or I had known anything about this we would have taken care and had the freeze done the same way we had his other eye done so this will hopeful never happen to it. Any answers or help would b much appreciated. For at 45 i can or could function but at 23 it is so much different.
I'm certainly glad to have stumbled on this thread, as I was just going to post some questions and comments to a new thread regarding floaters.
Of all my eye problems (glaucoma, ERM, visual field defect, IOL implants), floaters are by far the worst thing I'm enduring.
My floaters are not "black specks and dots, or cobwebs", but large blobs of translucent material that totally obscure my vision at times. My vision literally changes from second to second. The result is I can NEVER focus on text, detail, and now even faces or gross objects. My eyes both see something radically differently, due to an ERM in one eye that bends and twists all images, and when the blobs obscure the better eye, the eye with twisted images takes over for a moment, then the clear eye takes over again. Imagine this happening every second, 24 hours a day. It is unbelievably frustrating. My job and hobbies are now becoming almost impossible to do, and I've given up trying to read a newspaper. Post cataract surgery, there was a brief respite from the floaters, but now there appears to be more of them then before, and with PCO happening in each eye, and the resulting diminishing vision, they are back with a vengeance.
The advice to "ignore them", "the brain will get used to them", "they will settle to the bottom (I personally think that's a hoot)", "they are benign and MERELY an annoyance", are just so much drivel. They are life changing, paralyzing and in some cases dangerous (driving, for example).
I am also firmly convinced mine were initially the result of PVDs which were the result of SLT procedures for glaucoma. My ophthalmologists dispute the connection between SLT and PVD, but in my case, the first PVD occurred in the eye that had SLT done approximately 1 month post procedure, and the PVD in the second eye also happened 1 month post SLT in the other eye. Also, knowing what I know now, I believe it may have to do with the fact I was giving no anti-inflammatory meds post the SLT procedures, and the PVD, ERM and floaters were the result of an anti-inflammatory response. Again, I find no agreement with my hypothesis among the Dr's Ive asked about this, but I have no doubt it was at least a contributing factor. Connecting the dots between eye trauma, inflammatory response, and vitreous with some simple google searches add up to my conclusions. I also wonder about the constant dumping of chemicals in my eyes for many years for glaucoma. That has to have some effect on the vitreous.
I'm immensely frustrated, and now among those who if polled would accept risks to be rid of them. I am going to have a vitrectomy to try to improve the ERM situation, so that eye may be helped, but the other eye has more floaters by far.
Again, it is the constant CHANGING of vision that is such a big deal. A permanent visual field defect is something you can get used to for example, but if the "visual field defect" is a transitory thing changing constantly every minute of your life, there is absolutely no way the brain ca adjust to that.
Of all my eye problems (glaucoma, ERM, visual field defect, IOL implants), floaters are by far the worst thing I'm enduring.
My floaters are not "black specks and dots, or cobwebs", but large blobs of translucent material that totally obscure my vision at times. My vision literally changes from second to second. The result is I can NEVER focus on text, detail, and now even faces or gross objects. My eyes both see something radically differently, due to an ERM in one eye that bends and twists all images, and when the blobs obscure the better eye, the eye with twisted images takes over for a moment, then the clear eye takes over again. Imagine this happening every second, 24 hours a day. It is unbelievably frustrating. My job and hobbies are now becoming almost impossible to do, and I've given up trying to read a newspaper. Post cataract surgery, there was a brief respite from the floaters, but now there appears to be more of them then before, and with PCO happening in each eye, and the resulting diminishing vision, they are back with a vengeance.
The advice to "ignore them", "the brain will get used to them", "they will settle to the bottom (I personally think that's a hoot)", "they are benign and MERELY an annoyance", are just so much drivel. They are life changing, paralyzing and in some cases dangerous (driving, for example).
I am also firmly convinced mine were initially the result of PVDs which were the result of SLT procedures for glaucoma. My ophthalmologists dispute the connection between SLT and PVD, but in my case, the first PVD occurred in the eye that had SLT done approximately 1 month post procedure, and the PVD in the second eye also happened 1 month post SLT in the other eye. Also, knowing what I know now, I believe it may have to do with the fact I was giving no anti-inflammatory meds post the SLT procedures, and the PVD, ERM and floaters were the result of an anti-inflammatory response. Again, I find no agreement with my hypothesis among the Dr's Ive asked about this, but I have no doubt it was at least a contributing factor. Connecting the dots between eye trauma, inflammatory response, and vitreous with some simple google searches add up to my conclusions. I also wonder about the constant dumping of chemicals in my eyes for many years for glaucoma. That has to have some effect on the vitreous.
I'm immensely frustrated, and now among those who if polled would accept risks to be rid of them. I am going to have a vitrectomy to try to improve the ERM situation, so that eye may be helped, but the other eye has more floaters by far.
Again, it is the constant CHANGING of vision that is such a big deal. A permanent visual field defect is something you can get used to for example, but if the "visual field defect" is a transitory thing changing constantly every minute of your life, there is absolutely no way the brain ca adjust to that.
I have recently developed floaters in my left eye. In the past I have had them sporadically but they have gone away. Just the past week or so they have not gone away. It went to eye doctor and he basically said the same thing that they will eventually go away or the brain will get used to them. Does anyone know if the yag laser treatment is still considered risky? I am wiling to try I drive everyday for sales and it is hard to function. I have also heard of home remedies to get rid of floaters an suggestions?
Victoria
Victoria
The YAG laser should not be risky when correctly used. However they cannot treat floaters close to the retina. I've been for a consultation in the UK and my floaters are not treatable with this method, because of this.
Ash
Ash
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